Transosseous method

• US 9,962,174 B2
• Filed: 09/27/2016
• Issued: 05/08/2018
• Est. Priority Date: 07/17/2015
• Status: Active Grant

• Current Assignee: Crossroads Extremity Systems, Llc (Johnson & Johnson)
• Original Assignee: kator, LLC
• Inventors: Fallin, T. Wade, Helgerson, Joel
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US15/277,231
• Publication Number:
  US 20170112511A1
• Time in Patent Office: 588 Days
• Field of Search: 606 86 R, 606 96, 606 98, 606103, 606104, 606148-150, 606 62- 67, 606 79, 606232, 606233, 606 87, 623 1111, 623 1311- 1319
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1684 for the shoulder
• CPC Class Codes: A61B 17/1714 for applying tendons or ligaments implements for applying tendons or ligaments A61F2/0805
• CPC Class Codes: A61B 17/1778 for the shoulder
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 17/8861 Apparatus for manipulating flexible wires or straps devices for inserting Kirschner wires A61B17/1697
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61F 2/0805 Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0858 Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/0888 Anchor in or on a blind hole or on the bone surface without formation of a tunnel
• CPC Class Codes: A61F 2220/0016 with sharp anchoring protrusions, e.g. barbs, pins, spikes

Abstract

A method for securing a biceps tendon to a proximal portion of a humerus includes, in one example, forming a transosseous passage with openings on opposite sides of the biceps tendon. In another example, an instrument for use with the method includes a guide able to guide the formation of intersecting bone tunnels and a passer able to pass a member through the bone tunnels.

Claims

1. A method of securing a biceps tendon to a proximal portion of a humerus, the humerus having a proximal portion nearer the shoulder joint and a distal portion nearer the elbow joint, the biceps tendon being an elongate member extending proximal-distally, the method comprising:

forming a first tunnel into the proximal portion of the humerus from a first opening at a surface of the proximal portion of the humerus on a first side of the biceps tendon;

forming a second tunnel into the proximal portion of the humerus from a second opening at a surface of the proximal portion of the humerus on a second side of the biceps tendon, the second tunnel intersecting the first tunnel within the proximal humerus to form a continuous passage through the proximal humerus between the first and second openings;

passing a flexible element into the continuous passage, a first portion of the flexible element extending out of the passage through the first opening and a second portion of the flexible element extending out of the passage through the second opening;

passing at least one of the first and second portions of the flexible element over the biceps tendon between the first and second sides of the biceps tendon;

tensioning the flexible element; and

securing the flexible element to the proximal portion of the humerus.

2. The method of claim 1 further comprising wrapping at least one of the first and second portions of the flexible element around the biceps tendon.

3. The method of claim 1 further comprising passing at least one of the first and second portions of the flexible element through the biceps tendon.

4. The method of claim 1 further comprising abrading the proximal portion of the humerus adjacent the biceps tendon to promote attachment of the biceps tendon to the proximal portion of the humerus.

5. The method of claim 1 further comprising:

inserting a distal end of a first tunnel member into the proximal portion of the humerus along a first insertion axis, the first tunnel member having a proximal end opposite the distal end, the first tunnel member having a first longitudinal passage from the proximal end at least partway through the first tunnel member;

inserting a distal end of a second tunnel member into the proximal portion of the humerus along a second insertion axis, the second insertion axis intersecting the first insertion axis, the second tunnel member having a proximal end opposite the distal end, the second tunnel member having a second longitudinal passage from the proximal end at least partway through the second tunnel member; and

engaging a passer with the first and second longitudinal passages, the passer simultaneously extending through the first and second longitudinal passages and out of the proximal end of the first tunnel member and out of the proximal end of the second tunnel member.

6. The method of claim 5 comprising drilling at least one of the first and second tunnels to receive at least one of the first and second tunnel members.

7. The method of claim 5 comprising punching at least one of the first and second tunnel members into the proximal portion of the humerus to form at least one of the first and second tunnels.

8. The method of claim 5 wherein engaging the passer with the first and second tunnel members comprises inserting the passer so that it extends between the proximal end of the first longitudinal passage, the distal end of the first longitudinal passage, the distal end of the second longitudinal passage, and the proximal end of the second longitudinal passage.

9. The method of claim 5 wherein engaging the passer with the first and second tunnel members comprises inserting the passer so that it extends between an outer end of the first tunnel member spaced from the proximal portion of the humerus, an inner end of the first tunnel member buried in the proximal portion of the humerus, an inner end of the second tunnel member buried in the proximal portion of the humerus, and an outer end of the second tunnel member spaced from the proximal portion of the humerus.

10. The method of claim 5 wherein engaging the passer with the first and second tunnel members comprises advancing the passer into a proximal end of the second tunnel member, along the second longitudinal passage, through a second side opening in the second tunnel member, through a first side opening in the first tunnel member, along the first longitudinal passage, and out a proximal end of the first tunnel member.

11. The method of claim 10 wherein the distal end of the second tunnel member is inserted into the first side opening of the first tunnel member.

12. The method of claim 5 further comprising:

engaging the flexible element with the passer; and

withdrawing the passer to pass the flexible element through the first and second tunnel members.

13. The method of claim 1 wherein the step of securing the flexible element to the proximal portion of the humerus comprises inserting a knotless anchor into one of the first and second tunnels and securing the flexible element with the knotless anchor.

14. The method of claim 1 wherein the step of securing the flexible element to the proximal portion of the humerus comprises tying a knot in the flexible element.

15. The method of claim 1 further comprising placing a plate over the biceps tendon between the first and second openings and passing a portion of the flexible member over a portion of the plate.

16. The method of claim 15 wherein the plate includes a gripping surface and the gripping surface is placed in contact with the biceps tendon.

17. The method of claim 16 wherein the gripping surface includes a feature selected from the group consisting of spikes, ridges, and grit blast texturing.

18. The method of claim 15 wherein the plate includes an eyelet and a portion of the flexible element is passed through the eyelet.

19. The method of claim 1 further comprising:

inserting a first tunnel member into the proximal portion of the humerus along a first insertion axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member;

using a guide to select a second insertion axis from a plurality of insertion axes that each intersect the first insertion axis, each of the plurality of insertion axes forming a different angle relative to the first insertion axis;

inserting a second tunnel member into the proximal portion of the humerus along the selected second insertion axis, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member.

20. The method of claim 19 wherein the first tunnel member is attached to the guide and selecting a second insertion axis comprises selecting from a plurality of receivers on the guide, each of the plurality of receivers defining an insertion axis that intersects the first insertion axis at an angle different from the other of the plurality of receivers, each of the plurality of receivers being operable to receive the second tunnel member and guide it along an insertion axis.